VIBES | Client Declaration

VIBES Declaration Form

This form is required to be filled by every VIBES Client before visiting the clinic. Please note that this form is essential for your own Safety. The safety and wellbeing of our employees & Clients is our top priority. Your conscious participation and declaration in this questionnaire is very important for your and others protection, it will help us to take precautionary measures in workplace.

* Kindly Confirm your Appointment at the Clinic before filling this form (Date & Time of appointment is Mandatory).

* Required

Mobile Number *
Please enter 10 DIGIT mobile no. only. Do Not prefix "0" or "+91"
(Please use the number which you have used or you wish to use for registration & billing at VIBES; OTP Verification will be required)

Name *

Gender *

Email Id *

DOB *

City *

Center *

Service *

Appointment Date *

Appointment Time *

Please select mode of payment for Appointment *

  Pay Now Rs 118 (This amount excl. GST will be added to your Wallet and you can redeem it against exciting GIFT / Service Vouchers)

  Pay Lumpsum for Appointments (Pay Lump Sum amount for future Appointments & get 10% OFF)

  Pay at Center (No Wallet benefits are available)

VIBES Declaration Form

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